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Utilizing a Modified Care Coordination Measurement Tool to Capture Value for a Pediatric Outpatient Parenteral and
Louise E Vaz1, Cindi L Farnstrom1, Kimberly K Felder2
1Division of Pediatric Infectious Diseases, Doernbecher Children's Hospital.
Insights
Care coordination in pediatric outpatient parenteral antibiotic therapy (OPAT) programs is crucial. Nonreimbursable provider time spent on care coordination prevents emergency room visits and readmissions, demonstrating significant value beyond billed services.
Area of Science:
- Pediatric Infectious Diseases
- Healthcare Management
- Quality Improvement
Background:
- Outpatient parenteral or prolonged oral antibiotic therapy (OPAT) programs reduce inpatient costs by shifting care to outpatient settings.
- Care coordination (CC) is essential for successful patient transitions in OPAT.
- This study assessed outcomes of provider time dedicated to nonreimbursable CC activities in a pediatric OPAT program.
Purpose of the Study:
- To evaluate the impact and outcomes of nonreimbursable care coordination activities performed by providers in a pediatric OPAT program.
- To quantify the time spent on CC and its effect on patient care and healthcare utilization.
Main Methods:
- A qualitative feasibility pilot design was employed.
- The Care Coordination Measurement Tool was modified to capture nonreimbursable CC activities and outcomes.
- Data were collected over 44 work days for pediatric patients in an OPAT program.
Main Results:
- 154 nonreimbursable CC encounters were conducted by 2 infectious diseases providers for 29 pediatric patients.
- 54 hours (at least 6 workdays) were spent on CC, with 37% of time used for patients with complex social issues.
- CC prevented 10 emergency room visits and 2 readmissions, and facilitated 16 additional subspecialist and 13 primary care visits.
Conclusions:
- Nonreimbursable CC by OPAT providers is vital for preventing readmissions and ER visits.
- The value of pediatric OPAT programs is underestimated when solely considering reimbursable consultations and clinic visits.
- Investing in CC activities enhances patient care and optimizes healthcare resource utilization.
Background:
Outpatient parenteral or prolonged oral antibiotic therapy (OPAT) programs reduce inpatient healthcare costs by shifting care to outpatient settings. Care coordination (CC) is a necessary component to successfully transition patients. Our objective was to assess outcomes of provider time spent on nonreimbursable CC activities in a pediatric OPAT program.
Methods:
We used a qualitative feasibility pilot design and modified the Care Coordination Measurement Tool. We captured nonreimbursable CC activity and associated outcome(s) among pediatric patients enrolled in OPAT from March 1 to April 30, 2015 (44 work days) at Doernbecher Children's Hospital. We generated summary statistics for this institutional review board-waived QI project.
Results:
There were 154 nonreimbursable CC encounters conducted by 2 infectious diseases (ID) providers for 29 patients, ages 17 months-15 years, with complex infections. Total estimated time spent on CC was 54 hours, equivalent to at least 6 workdays. Five patients with complex social issues used 37% of total CC time. Of 129 phone events, 38% involved direct contact with families, pharmacies (13%), primary care providers (13%), and home health nursing (11%). Care coordination prevented 10 emergency room (ER) visits and 2 readmissions. Care coordination led to 16 additional, not previously scheduled subspecialist and 13 primary care visits. The OPAT providers billed for 32 clinic visits during the study period.
Conclusions:
Nonreimbursable CC work by OPAT providers prevented readmissions and ER visits and helped facilitate appropriate healthcare use. The value of pediatric OPAT involvement in patient care would have been underestimated based on reimbursable ID consultations and clinic visits alone.